BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Kevin de León, Chair
AB 154 (Atkins) - Abortion.
Amended: June 24, 2013 Policy Vote: B&P 8-2, Health 7-2
Urgency: No Mandate: Yes
Hearing Date: August 12, 2013
Consultant: Brendan McCarthy
This bill does not meet the criteria for referral to the
Suspense File.
Bill Summary: AB 154 would authorize nurse practitioners,
certified nurse midwives, and physician assistants to perform
aspiration abortions, provided certain training and procedural
requirements are met.
Fiscal Impact:
One-time costs up to $150,000 for the adoption or revision
of regulations by the Board of Registered Nursing (Board of
Registered Nursing Fund).
One-time costs up to $150,000 for the adoption or revision
of regulations by the Medical Board of California
(Contingent Fund of the Medical Board of California).
Indeterminate impact on state health care programs, such as
Medi-Cal and CalPERS (various funds). While the impact on
state programs is not known, the bill is not likely to
increase overall state spending on those programs.
By authorizing more health care providers to provide first
trimester aspiration abortions, it is possible that the bill
will increase the overall number of abortions performed in
the state. However, this impact is uncertain. It is not
known whether limitations in the number of providers for
first trimester abortions actually limits the number of
abortions that are performed in the state. Currently, women
who desire a first trimester abortion and face a shortage of
providers may travel to an area where services are available
or delay their abortion until later in the pregnancy. In
such cases, this bill would not increase the overall number
of abortions. Given that the cost to provide a first
AB 154 (Atkins)
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trimester aspiration abortion is less than the cost to
provide a second trimester surgical abortion, greater access
to first trimester aspiration abortions may reduce state
health care costs.
Background: Under current law, only physicians are authorized to
perform surgical abortions (which includes aspiration abortion).
Nurse practitioners, certified nurse midwives, and physician
assistants are authorized in law to provide non-surgical
abortion (through pharmacological agents).
The Health Workforce Pilot Program within the Office of
Statewide Health Planning and Development is authorized to
designate experimental health workforce projects to study
potential changes to the state's licensing requirements. This
program has been used to study whether certain health
practitioners can safely expand their scope of practice. Under a
study authorized by the program, existing statutory and
regulatory limits on the practice by health care providers can
be waived for participants in the study.
Health Workforce Pilot Program Number 171 (Advancing New
Standards in Reproductive Health) allows participating nurse
practitioners, certified nurse midwives, and physician
assistants to perform first trimester aspiration abortions,
provided specified training requirements are met. According to a
report published on the results of the study, the complication
rate between procedures performed by physicians (0.9%) was
similar to the complication rate for procedures performed by
nurse practitioners, certified nurse midwives, and physician
assistants (1.8%) and the rate of serious complications between
the two groups was the same (0.03%).
Proposed Law: AB 154 would authorize nurse practitioners,
certified nurse midwives, and physician assistants to perform
aspiration abortions, provided certain training and procedural
requirements are met.
Specific provisions of the bill would:
Permit nurse practitioners, certified nurse midwives, and
physician assistants who have completed training through the
Health Workforce Pilot Program or completed training
recognized by the Board of Registered Nursing or the
California Medical Board to perform aspiration abortions
AB 154 (Atkins)
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following standardized procedures;
Specify the training requirements for nurse practitioners,
certified nurse midwives, and physician assistants;
Specify physician supervision requirements;
Make it unprofessional conduct for a nurse practitioner,
certified nurse midwife, or physician assistant to perform
an aspiration abortion without meeting training
requirements.
Related Legislation:
SB 491 (Hernandez) would authorize nurse practitioners to
perform certain tasks, such as examining patients and
establishing a diagnosis, independently. That bill is in the
Assembly Business, Professions and Consumer Protection
Committee.
SB 623 (Kehoe, Statutes of 2012) extended the Health
Workforce Pilot Program Number 171 until January 1, 2014.
SB 1338 (Kehoe, 2012) would have authorized nurse
practitioners, certified nurse midwives, and physician
assistants who have completed training through the Health
Workforce Pilot Program Number 171 to continue to provide
aspiration abortions. That bill failed passage in the Senate
Business, Professions, and Economic Development Committee.
Staff Comments: The only costs that may be incurred by local
agencies under the bill relate to crimes and infractions. Under
the California Constitution, such costs are not reimbursable by
the state.